Revista Gaúcha
de Enfermagem
DOI: http://dx.doi.org/10.1590/1983-1447.2015.03.50263
Living and health conditions
of elderly people over 80
Condições de vida e de saúde de idosos acima de 80 anos Condiciones de vida y salud de personas mayores de 80 anos
a Universidade de Lins, Lins, São Paulo, Brasil. b Universidade Estadual Paulista (UNESP), Campus
Botucatu. Faculdade de Medicina. Programa de Pós-Graduação em Ensino em Saúde. Programa de Mestrado e Doutorado em Enfermagem. Curso de Enfermagem. Botucatu, São Paulo, Brasil.
c Faculdade de Medicina de Marília (FANEMA). Curso
de Enfermagem. Marília, São Paulo, Brasil. Sabrina Piccinelli Zanchettin Silvaa
Maria José Sanches Marinb
Márcia Renata Rodriguesc
ABSTRACT
Objective: This article proposes to describe demographic data and health conditions of elderly people at age 80 or more. Method: Quantitative-descriptive study of 95 elderlies from fi ve units of the Family Health Strategy in the period from September to December 2013, using script with general data of the living conditions and health, including validated scales in geriatrics and gerontology.
Results: The average age was 85.4 years. There was a predominance of women. Most were widowers with family income, more
fre-quently between 2 or 3 minimum wages and economic participation is for means of sharing responsibility. They present dependency for many of Daily Living Instrumental Activities and, on average, reported 2.2 diseases. Fear of falling, decreased vision and hearing as well as pain in diff erent body regions are reported.
Conclusion: It appears that they have more intense needs than the elderly in general, requiring new ways of organizing their health care. Keywords: Determination of health care needs. Elderly of 80 years or more. Social conditions.
RESUMO
Objetivo: Propõe-se a descrever dados sociodemográfi cos e as condições de saúde de idosos com 80 anos ou mais.
Método: Estudo quantitativo-descritivo realizado com 95 idosos de cinco unidades da Estratégia Saúde da Família, no período de setembro a dezembro de 2013, utilizando roteiro com dados gerais das condições de vida e de saúde, incluindo escalas validadas em geriatria e gerontologia.
Resultados: A média de idade foi de 85,4 anos. Houve predomínio de mulheres. A maioria viúvos com renda familiar, mais
frequen-te, de 2 a 3 salários mínimos, e a participação econômica é a de dividir responsabilidade. Apresentam dependência para muitas das Atividades Instrumentais de Vida Diária e, em média, referiram 2,2 doenças. Referem medo de cair, diminuição da visão e da audição, além de dor em diferentes regiões do corpo.
Conclusão: Depreende-se que eles apresentam necessidades mais intensas dos que os idosos em geral, demandando novas formas
de organizar seu cuidado em saúde.
Palavras-chave: Determinação de necessidades de cuidados de saúde. Idoso de 80 anos ou mais. Condições sociais.
RESUMEN
Objetivo: Se propone a describir las condiciones de vida y la salud de las personas mayores de 80 años o más.
Método: Estudio cuantitativo-descriptivo realizado con 95 personas de cinco unidades de la Estrategia Salud de la Familia, mediante un guión con los datos generales de las condiciones de vida y de salud, incluyendo escalas validadas en geriatría y gerontología.
Resultados: La edad promedio fue de 85,4 años. Las mujeres predominaron en la mayoría de los viudos, el ingreso familiar más común es de 2-3 salarios mínimos. La dependencia actual de muchas de las actividades instrumentales de la vida diaria, en promedio 2.2 enfermedades reportadas y medicamentos utilizados 4.3 / ancianos. Mencionan el miedo de caerse, disminución de la visión, y dolor en diferentes regiones del cuerpo.
Conclusión: Parece que tienen necesidades más intensas de las personas mayores en general, lo que requiere la preparación de la sociedad para cumplir con la misma efi cacia.
INTRODUCTION
In Brazil, the aging process has been characterized as one of the most signifi cant social phenomena for society in general(1), interfering, especially in the economic as-pects and those linked to health care, which require new arrangements to meet the needs of this segment of the population.
In this context, the population with an age of 80 and over is the fastest growing and projections indicate that while the population aged 60 and over will triple by 2100, to people aged 80 or more is expected to increase nearly seven times the same period. In absolute num-bers, it can exceed 120 million people in 2013 to 830 million in 2100(2).
Based on the realization that the more advanced the age, the higher the tendency of changes and problems resulting from this process, we can deduce that the diff er-ence between the health conditions of the younger and older elderly, with the latter being more vulnerable to fra-gility and functional limitations(3).
Faced with the lack of preparedness of society to deal with the condition of social, biological and psychological vulnerability of the elderly, where their everyday becomes permeated with intense problems involving the deval-uation of pensions, the lack of assistance and leisure ac-tivities, misinformation and the precariousness of public investment to meet the special needs of the age group(4). In health, despite policies aimed towards the elderly, strat-egies that meet the real needs of these people are still lack-ing, with the purpose of planning actions that are appro-priate to their situation.
In the Brazilian reality, there are few studies that spe-cifically approach that age range. Thus, the studies that seek to expand knowledge about the living conditions and health of seniors of 80 years or so are justified, for, when making their needs evident, they will contribute to the care planning and decision making of profession-als working in primary care, mainly of nurses who are assigned essentially to care for individuals, families and communities.
In face of this, the present study begins with the follow-ing questions: How are the livfollow-ing conditions and health of the elderly, against the vulnerability they face? To what ex-tent has the increase in life expectancy been accompanied by the maintenance of autonomy for instrumental activi-ties of daily living and cognitive ability? What are the most prevalent diseases in this population?
The study aims to describe sociodemographic data and health conditions of elderlies aged 80 or more.
METHOD
It is a cross-sectional study conducted in the city of Marilia, located in the Midwest Paulista region, with ap-proximately 220,000 inhabitants. The primary care of the municipality has 12 Basic Health Units (UBS) and 34 Family Health Units (USF). The USF serve approximately 110,000 people, representing around 50% of the popula-tion of Marilia.
The study population consisted of seniors aged 80 and over. According to the City Health Department, in 2013, 1996 elderlies were registered in the health units. Consid-ering the total population of seniors over 80 years of age in the city and using the sample calculation with a 95% confi -dence interval, taking into account 10% error, we obtained a sample of 92 elderlies.
Inclusion criteria was: being 80 years or older and resid-ing in urban areas, where those who were not found in the home after two attempts were excluded.
The catchment areas covered fi ve USF, selected through raffl e and identifi ed with the letters A, B, C, D and E. These units counted with 229 elderly in the interest age group. To meet the sample calculation, the proportion of elderlies over 80 years old in the selected units was respected and around 40% of the elderlies of each unit were interviewed and / or visited. Thus, 95 individuals were interviewed, where 17, 39, 15, 10 and 14 were from units A, B, C, D and E, respectively. To locate them, we used a list provided by Community Health Agents (ACS), sequentially.
The data collection instrument verifi ed demographic data that give indicative living conditions, such as age, sex, marital status, religion, education, fi nancial resources and economic participation within the family income. The self-health perception was assessed with the question: how do you consider your health? With this question, there were six possibilities of response (excellent, good, regular, bad, bad and do not know / no answer).
Exam-ination, validated in Brazil(8) with scores 0-30, having a cut grade of 18, given the low level of education of respon-dents, aims to trace the cognitive level of the elderly.
Data collection occurred from September to December 2013, in home of the elderly itself, and was conducted by the principal investigator. Each interview lasted an average of 30 minutes. If the elderly presented speech diffi culty or diffi culty in understanding of the questions, the primary caregiver was asked to provide the information. It is note-worthy that, on the pain assessment, depression and men-tal state scale, if the respondent was unable to answer, the instrument would not be applied.
After collecting the data, they were coded and en-tered into an Excel spreadsheet for statistical analysis us-ing SPSS v. 17.
The study counted with the approval of the Ethics and Human Research of the Faculdade de Medicina de Marília, Opinion No. 259 969 and CAAE 14742813.6.0000.5413. Par-ticipants were informed about the purpose and procedure of the study, data collection was performed after the con-ditions were agreed to and the Free and Informed Consent Form was signed.
RESULTS
Among the 229 elderly, 180 (78.9%) were visited; of these, 34 (18.9%) were not found at home after two at-tempts; 26 (14.5%) refused to participate; 13 (7.3%) had an address that could not be found; 7 (3.9%) had moved and 5 (2.8%) had died. Thus, the data were collected from 95 elderly.
The age of the elderly ranged from 80 to 102 years, with an average of 85.4 years. There was a predominance of women 62 (65.2%); the majority, 55 (57.9%), lives without a partner (a) and is Catholic 69 (72.6%). Of the interviews, 19 (20%) were answered by the principal or family caregiver. Family income of 48 (50.5%) elderlies was 2 to 3 times the minimum wage. The economic role of the elderly within the family income was that of sharing responsibility for 50 participants (53.2%), as shown in Table 1.
In Table 2, data of the health conditions of the elder-ly, which were obtained through self-report. On self-rated health, 37 (39%) defi ned it as good. In the year preceding the study, 37 (38.9%) of respondents reported having expe-rienced one or more falls. As for vision, 29 (30.5%) reported not seeing at the time and 40 (42.1%) said they had diffi -culty hearing. Regarding the presence of pain, 56 (58.9%) responded affi rmatively.
During the verifi cation of instrumental activities (Table 3), it is emphasized that most of the elderly had some
de-Variables N (%)
Age
80 – 84 49 (51.5)
85 – 89 32 (33.7)
90 – 94 7 (7.3)
95 – 99 5 (5.3)
100 + 2 (2.2)
Sex
Female 62 (65.2)
Marital status
Living alone 6 (6.3)
Living with partner 32 (33.7)
Widower 55 (57.9)
Divorced 2 (2.1)
Religion
Catholic 69 (72.6)
Evangelical 18 (18.9)
Others 8 (8.5)
Education
Illiterate / Incomplete Elementary School 77 (81.0)
Completed Elementary School 7 (7.4)
High School Incomplete / Complete 6 (6.3)
College Incomplete / Complete 5 (5.3)
Family income
Up to 1 MW* 17 (17.2)
From 2 to 4 MW 48 (50.5)
From 4 to 5 MW 10 (10.7)
Above 5 MW 11 (11.8)
Does not know / did not answer 9 (9.68)
Senior Citizen Income Origin
Retirement / Pension 82 (86.3)
Others 13 (13.7)
Economic participation of the elderly in family income
Sole / most responsible 36 (38.3)
Divides responsibilities 50 (53.2)
No participation 9 (8.5)
Table 1 – Socio-demographic characteristics of the elderly over 80 years of age. Marilia, São Paulo, 2014
Source: Survey data, 2014.
pendency, most frequent being to take trips alone 4 (4.2%) and to perform heavy tasks, 11 (11.6%).
The diseases listed by the elderly are in Table 4, where those of the nervous, circulatory and digestive system were the most prevalent. An average of 2.2 diseases per individ-ual were reported.
DISCUSSION
In order to characterize demographic data and health conditions of the elderly over 80 years in this study, it be-came clear that some aspects make them more vulnerable to limitations in living conditions and depending on other people, although in other respects they resemble the el-derly of other age groups.
A signifi cant proportion of women were found among such elderlies, highlighting their predominance in this stage of life. The fact that women are less exposed to vio-lence and accidents, besides being more careful with their health, seeking health services more often are some of the explanations for this greater longevity(9).
As for marital status, most of the sample lives without a partner, as has been shown in studies with the elderly population in general, but to a lesser extent. One study (10) performed with elderlies, in Paraná, showed that approxi-mately 34% of respondents were widowed. In those who are age 80 and over, this fi gure rises to 63% or so.
Regarding the level of education, it appears that the majority of respondents have not fi nished elementary school, which confi rms national study(10-11). Associated to this, it has been found that the highest concentration of illiterates is among people of higher age, and in Brazil, the elderly have on average of 4.2 years of educaton(12).
This study, unlike what the IBGE reveals(12), showed that only a small portion of this population lives with an income at or below the minimum wage. Even if in this study it has been found that most live on less than 2 to 3 minimum wages, this data proves a condition of economic need, given that elderlies above 80 years of age have become more vulnerable and have specifi c needs in regards to the maintenance of good living conditions, including trans-portation, housing, recreation and food, among others. Moreover, a large proportion of respondents, even those over the age of 80, are the sole or main responsible for the household, which corroborates with the reality found in the IBGE survey.
With regard to self-perceived health, a condition result-ing from determinresult-ing factors such as age, gender, family support, marital status, education and employment oppor-tunities, income, functional capacity, health and lifestyle,
Health conditions N (%)
Self-perception of health conditions
Great. 17 (17.9)
Good 37 (39.0)
Regular 18 (18.9)
Bad 5 (5.3)
Awful 6 (6.3)
Does not know/ did not answer 12 (12.6) Falls
No 58 (61.1)
1 to 2 30 (31.6)
3 to 4 5 (5.2)
5 or + 2 (2.1)
Fear of falling
Yes 67 (70.5)
No 28 (29.5)
Vision
Excellent 2 (2.1)
Good 28 (29.5)
Regular 36 (37.9)
Bad 16 (16.8)
Awful 9 (9.5)
Does not see 4 (4.2)
Hearing
No problems 37 (39.0)
Hears with some diffi culty 23 (24.2) Hears with diffi culty 17 (17.9) Hears with a signifi cant amount of diffi culty 13 (13.6)
Does not hear 5 (5.3)
Mastication
Never has diffi culty 61 (64.2) Rarely has diffi culty 8 (8.4) Frequently has diffi culty 5 (5.3) Sometimes has diffi culty 11 (11.6) Always has diffi culty 10 (10.5) Pain complaint
Yes 56 (64.2)
Does not know / did not answer 7 (7.4) Pain assessment**
Zero 6 (6.8)
Three 22 (25.0)
Six 15 (17.0)
Eight 9 (10.2)
Ten 4 (4.6)
Does not know / did not answer 32 (36.4) Depression Scale Rating
Suspected depression and loneliness 28 (29.5) Cognitive assessment
Mini Mental State Examination
Grade Below 18 18 (19.0)
Table 2 – Health characteristics of the elderly over 80 years of age. Marilia, São Paulo, 2014
Source: Survey data, 2014.
among others (11-13), was considered good or excellent by most respondents.
With regard to falls, we observe numbers close to those found in another study in Santa Catarina(14), with seniors 80 years old or more, in which approximately 44% of the people interviewed had at least one episode in the last 12 months.
With regard to vision, it is known that with aging, there are changes in visual acuity, causing limitations in devel-opment activities capacity and that bring negative conse-quences to the quality of life(11).
In hearing ability assessment, it was found that most had some diffi culty. The elderly with this kind of diffi culty is seen as confused, disoriented, distracted, and uncommu-nicative. In addition to these consequences, depression, anxiety and social isolation can also arise (15).
The oral health problems, in turn, are very common in the elderly. In this survey, 64.2% of respondents have no
Activity Dependency level N (%)
In relation to the phone
Receives and make calls 51 (53.7)
Needs assistance to make phone calls 15 (15.8)
Does not have the habit or is unable to use the phone 29 (30.5)
In relation to travel
Travels alone 4 (4.2)
Only travels with company 37 (38.9)
Does not have the habit or is unable to travel 54 (56.9)
In relation to shopping
Goes shopping, when transport is supplied 25 (26.3)
Only go shopping when they have company 14 (14.7)
Does not have the habit or is unable to shop 56 (59.0)
In relation to meal preparation
Plans and cooks full meals 30 (31.6)
Only prepares small meals or when they receive help 20 (21.1) Does not have the habit or is unable to cook meals 45 (47.3)
In relation to domestic work
Performs heavy tasks 11 (11.6)
Performs light tasks, needing help with heavy tasks 38 (40.0)
Does not have the habit or is unable to perform housework 46 (48.4)
In relation to medication use
Makes use of medications without assistance 46 (48.4)
Needs assistance or reminders 26 (27.4)
Is unable to solely control the use of medication 23 (24.2)
In relation to handling money
Fills out checks and pays bills without aid 41 (43.1) Needs assistance for handling checks and bills 13 (13.7) Does not have the habit of dealing with money or is unable to handle
money, bills ... 41 (43.2)
Table 3 – Dependency for instrumental activities of daily living of the elderly over 80 years of age. Marilia, São Paulo, 2014
Source: Survey data, 2014.
Diseases * N (%)
Systemic Arterial Hypertension 62 (65.2) Diabetes Mellitus (1 and 2) 17 (17.9)
Arthrosis 14 (14.7)
Osteoporosis 14 (14.7)
Cataract 8 (8.4)
Previous stroke history 8 (8.4)
Glaucoma 8 (8.4)
Alzheimer Disease 4 (24,)
Arthritis 3 (3,1)
Gastritis 3 (3.1)
Others 63 (66.3)
Table 4 – Diseases reported by the elderly over 80 years of age. Marilia, São Paulo, 2014
diffi culty in chewing, a fact that is very important for the quality of food intake, given that preserving oral health ag-gregates welfare, as well as improves nutrition, self-image and quality of life (16).
Among the changes in the health conditions of the el-derly over 80 years of age, pain was present in most state-ments. The pain can be a limiting factor for function, capa-ble of increasing agitation, emotional stress, and the risk of mortality. The aff ected individual may have their daily activities compromised, leading to physical and functional disability, dependency, social withdrawal, changes in fami-ly dynamics and economic imbalance (17). The pain is there-fore confi gured as a public health problem that should be valued and assessed, especially in the elderly, given that in this stage of life, many complaints of pain are attributed to age and / or own aging and are usually not treated (17).
The proportion of elderlies depression signs found in this study shows resemblance to what happens to the elderly in general. Negative events, social problems, pres-ence of physical illness and incapacity, common to this age group, in turn, increases the chances of developing depression (18).
In the cognitive assessment, the proportion of elderly people with defi cit was similar to the survey of elderlies who were 80 years or older, who had 2.45 more chances to present it, compared to younger elderly (19).
In daily living activities examination, it is emphasized that the dependency is presented in activities that are more instrumental. Among the items evaluated, the abil-ity to shop is the one that causes the most dependency, because it requires greater physical and cognitive eff ort. In addition, studies have shown association of this diffi culty with the low education of the elderly (20).
The elderly studied had an average of 2.2 comorbidi-ties, the most prevalent being Arterial Hypertension and Mellitus Diabetes, which does not diff er from the evidence found in studies conducted with elderly in general (9).
CONCLUSION
As for the limitations, because it is a local study, is not possible to generalize the results. In addition, data were collected in fi ve ESF units that, although selected by lot-tery, cannot represent all of the units. Additionally, the el-derly and families provided the data, with the possibility of recall bias. The presence of disease was also information given by the elderly or family and may diff er from the actu-al number. Still, the study provides an approach to aspects involving this population, which may contribute to greater understanding of this phase of life.
Data obtained between 96 seniors over 80 years, reveal living conditions and health disadvantageous to a quality survival, including little or no schooling, widowhood, the presence of dependency for the Instrumental Activities of Daily Living, the auditory and visual decline and the pres-ence of pain in diff erent body regions.
It is concluded that at this stage of life, it is unlikely that the elderly can manage their own life without depending on others, which to our reality, is usually a placement oc-cupied by a family member. As such, it seems appropriate that the policies be strengthened towards the elderly, so that they are ensured dignifi ed care at this stage of life, as family support is not always suffi cient.
REFERENCES
1. Lebrão ML. O envelhecimento no Brasil: aspectos da transição demográfi ca e epidemiológica. Saúde Coletiva. 2007;4(17):134-40.
2. United Nations. World Population 2012 [Internet]. New York: United Nations; 2012 [cited in 2014 maio 5]. Available at: http://www.un.org/en/develop-ment/desa/population/publications/pdf/trends/WPP2012_Wallchart.pdf 3. Enkvist Å, Ekström H, Elmståhl S. Associations between functional ability and
life satisfaction in the oldest old: results from the longitudinal population study Good Aging in Skåne. Clin Interv Aging. 2012;7:313-20.
4. Parahyba MI, Simões CCS. A prevalência de incapacidade funcional em idosos no Brasil. Ciênc Saúde Coletiva. 2006;11(4):967-74.
5. Fundação Antônio Prudente (BR), Centro de Tratamento e Pesquisa do Hospital de Câncer. Saúde em movimento. Dor: mensuração [Internet]. São Paulo (SP): Fundação Antônio Prudente; 2002 [cited in 2013 maio 20]. Available at: http:// www.saudeemmovimento.com.br/conteudos/conteudo_exibe1.asp?cod_no-ticia=39
6. Santos RL, Virtuoso Júnior JS. Confi abilidade da versão brasileira da escala de atividades instrumentais da vida diária. RBPS. 2008:21(4):290-6.
7. Paradela EMP, Lourenço RA, Veras RP. Validação da escala de depressão geriátrica em um ambulatório geral. Rev Saúde Pública. 2005;39(6):918-23.
8. Bertolucci PHF, Brucki SMD, Campacci SR, Juliano Y. O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuro-Psiquiatr. 1994;52(1):1-7.
9. Salgado CDS. Mulher idosa: a feminização da velhice. Estud Interdiscip Envelhec. 2002;4(1):7-19.
10. Pilger C, Menon MH, Mathias TAF. Características sociodemográfi cas e de saúde de idosos: contribuições para os serviços de saúde. Rev Latino-Am Enfermagem. 2011:19(5):1230-8.
11. Silva SPZ, Marin MJ, Rodrigues MR. Condições de vida e saúde dos idosos com idade igual ou acima de 80 anos [dissertação]. Marília (SP): Faculdade de Medi-cina de Marília; 2015.
12. Instituto Brasileiro de Geografi a e Estatística. Síntese de indicadores sociais: uma análise das condições de vida da população brasileira 2013[Internet]. Rio de Janeiro (RJ):IBGE; 2013 [cited in 2014maio 20]. Available at: http://biblioteca. ibge.gov.br/visualizacao/livros/liv66777.pdf
14. Farias RG, Santos SMA. Infl uência dos determinantes do envelhecimento ativo entre idosos mais idosos. Texto Contexto Enferm. 2012;21(1):167-76. 15. Santos SB, Oliveira LB, Menegoto IH, Bós AJG, Soldera CLC. Difi culdades
per-cebidas por moradores longevos e não longevos de uma instituição de longa permanência para idosos. Estud Interdiscipl Envelhec. 2012;17(1):125-43. 16. Costa JSD, Galli R, Oliveira EA, Backes V, Vial EA, Canuto R, et al. Prevalência de
capacidade mastigatória insatisfatória e fatores associados em idosos brasileiros. Cad Saúde Pública. 2010;26(1):79-88.
17. Celich KLS, Galon C. Dor crônica em idosos e sua infl uência nas atividades da vida diária e convivência social. Rev Bras Geriatr Gerontol. 2009;12(3):345-59.
18. Shear K, Roose SP, Lenze EJ, Alexopoulos GS. Depression in the elderly: the unique features related to diagnosis and treatment. CNS Spectr. 2005 Aug;10(8 Suppl 10):1-13.
19. Holz AW, Nunes BP, Thumé E, Lange C, Facchini LA. Prevalência de défi cit cogni-tivo e fatores associados entre idosos de Bagé, Rio Grande do Sul, Brasil. Rev Bras Epidemiol. 2013;16(4):880-8.
20. Fialho CB, Lima-Costa MF, Giacomin KC, Loyola Filho AI. Capacidade funcional e uso de serviços de saúde por idosos da região metropolitana de Belo Horizon-te, Minas Gerais, Brasil: um estudo de base populacional. Cad Saúde Pública. 2014;30(3):599-610.
Author’s address:
Sabrina Piccinelli Zanchettin Silva Av. Feres Mattar, 493, Fragata 17519-240 Marília – SP
Email: [email protected]
